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Background <p>Reliable preoperative biomarkers are needed to improve risk stratification in colorectal cancer (CRC). The prognostic value of a combined score based on multiple serum tumor markers remains underexplored.</p> Methods <p>This retrospective study included 307 CRC patients undergoing curative surgery. A preoperative risk score was defined by the number of elevated markers (AFP, CA19-9, CA125, CA724, CA153) above institutional cut-offs. Patients were stratified into low-risk (≤ 1 elevated marker) and high-risk (&gt; 1 elevated marker) groups. Associations with 5-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression. Subgroup analysis by tumor size (≤ 4&#xa0;cm vs. &gt;4&#xa0;cm) was performed.</p> Results <p>A low-risk score (≤ 1 elevated marker) was independently associated with improved 5-year OS (adjusted HR = 0.60, 95% CI: 0.37–0.97, <i>P</i> = 0.038) and showed a strong trend for better DFS (adjusted HR = 0.65, 95% CI: 0.42-1.00, <i>P</i> = 0.051) after adjusting for clinicopathological factors. Strikingly, this prognostic association was significant only in patients with tumors ≤ 4&#xa0;cm (for OS: HR = 0.19, <i>P</i> = 0.003; for DFS: HR = 0.34, <i>P</i> = 0.010) but not in those with larger tumors (<i>P</i> &gt; 0.05). The interaction between tumor size and the marker score on OS approached statistical significance (<i>P</i> for interaction = 0.051).</p> Conclusion <p>A simple preoperative multi-marker score is an independent prognostic factor for survival in CRC. Its predictive power is particularly strong in patients with smaller tumors (≤ 4&#xa0;cm), suggesting a valuable role in refining preoperative risk assessment for this subgroup.</p>

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Preoperative tumor marker burden score predicts survival in colorectal cancer according to tumor size

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月16日

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  • Dan Tao,
  • Hui He,
  • Jie Chen,
  • Xiaojun Li

摘要

Background

Reliable preoperative biomarkers are needed to improve risk stratification in colorectal cancer (CRC). The prognostic value of a combined score based on multiple serum tumor markers remains underexplored.

Methods

This retrospective study included 307 CRC patients undergoing curative surgery. A preoperative risk score was defined by the number of elevated markers (AFP, CA19-9, CA125, CA724, CA153) above institutional cut-offs. Patients were stratified into low-risk (≤ 1 elevated marker) and high-risk (> 1 elevated marker) groups. Associations with 5-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression. Subgroup analysis by tumor size (≤ 4 cm vs. >4 cm) was performed.

Results

A low-risk score (≤ 1 elevated marker) was independently associated with improved 5-year OS (adjusted HR = 0.60, 95% CI: 0.37–0.97, P = 0.038) and showed a strong trend for better DFS (adjusted HR = 0.65, 95% CI: 0.42-1.00, P = 0.051) after adjusting for clinicopathological factors. Strikingly, this prognostic association was significant only in patients with tumors ≤ 4 cm (for OS: HR = 0.19, P = 0.003; for DFS: HR = 0.34, P = 0.010) but not in those with larger tumors (P > 0.05). The interaction between tumor size and the marker score on OS approached statistical significance (P for interaction = 0.051).

Conclusion

A simple preoperative multi-marker score is an independent prognostic factor for survival in CRC. Its predictive power is particularly strong in patients with smaller tumors (≤ 4 cm), suggesting a valuable role in refining preoperative risk assessment for this subgroup.